Provider Demographics
NPI:1427235365
Name:WYNN, MELISSA R (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:WYNN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:R
Other - Last Name:BECOTTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-6058
Mailing Address - Country:US
Mailing Address - Phone:774-476-0240
Mailing Address - Fax:774-374-8050
Practice Address - Street 1:1599 ORLEANS RD
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645
Practice Address - Country:US
Practice Address - Phone:774-216-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist